1 10/9/2018

Fuzzie Buddies General Application

How did you hear about us?

*For each client you refer to us, you will receive a $10 off coupon. The coupon will be emailed to you after the client you referred has come in for their reservation.

Owner______Date ______

Address______

City______State______Zip______

Phone (____)______Fax______Email

EmergencyContact______Phone (____)

Veterinarian______

City______State______

Phone (____)______Fax______

Pet: Dog_____Cat_____Male_____Female_____Neutered/Spayed Y___ N___

Name______Breed______

Color______Age

Pet: Dog_____Cat_____Male_____Female_____Neutered/Spayed Y___ N___

Name______Breed______

Color______Age

Pet: Dog_____Cat_____Male_____Female_____Neutered/Spayed Y___ N___

Name______Breed______

Color______Age

Pet: Dog_____Cat_____Male_____Female_____Neutered/Spayed Y___ N___

Name______Breed______

Color______Age

Vaccinations: Please fax proof of vaccinations prior to stay. Fax (813) 248-3233

Dogs: Rabies, DHLPP, Bordetella within 6 months, Canine Influenza(H3N8).

Cats:Rabies, FVRCP

Health and Temperament Certification

I,______, hereby certify that my pet(s)

______

are in good health and have not been ill with any communicable disease in the last 30 days.

I further certify that my dog (s) have not harmed or shown aggressive or threatening behaviortoward any person or other dog.

Fuzzie Buddies

Tampa, FL

Name of Owner______

Signature______Date______

Your Pet Circle One

(If yes to any of the following, please explain in special instructions section below)

1. Does your pet have trouble with stairs? Yes No

2. Does your pet have arthritis? YesNo

3. Does your pet have hip displaysia? Yes No

4. Has your pet had any recent surgeries or injuries? Yes No

5. Does your pet have sensitive areas or areas to avoid? Yes No

6. Is your pet a jumper/leaper (N/A for cats) Yes No

7. Has your pet ever climbed a fence? (N/A for cats) Yes No

8. Is your pet toy aggressive/protective? Yes No

9. Has your pet ever bitten someone? Yes No

10. Is your pet on any medications? Yes No

11. Does your pet have any allergies? Yes No

12. Is your pet on a prescription diet? Yes No

13. Is your pet a finicky eater? Yes No

14. Is your pet food aggressive/protective? Yes No

15. Is your pet afraid of thunderstorms or fireworks? Yes No

Brand of Food:

Any Special Instructions:

FUZZIE BUDDIES CARE FOR YOUR PET

  1. Fuzzie Buddies shall exercise reasonable care for your pet for the duration of the pets stay. If the pet becomes ill or if the state of the pet’s health otherwise requires professional attention, Fuzzie Buddies, in its sole discretion, may engage the services of a veterinarian, administer medicine or give other requisite attention to the pet and the expenses thereof shall be paid by the owner.

OWNER ASSURANCES

  1. Owner specifically represents to Fuzzie Buddies that their pet(s) has not been exposed to rabies, distemper or been ill within a thirty-day period prior to boarding. Owner also agrees to be solely responsible for all acts of behavior of their pet while in the care of Fuzzie Buddies.
  2. It is expressly agreed by Owner and Fuzzie Buddies that Fuzzie Buddies’ liability shall in no event exceed the lesser of the current value of the pet of the same species or the sum of $100.00 per pet boarded.
  3. By signing this contract, the owner certifies the accuracy of all information given to Fuzzie Buddies and that they are the sole owner of the pet – free and clear of all liens and encumbrances.

PAYMENT OF CHARGES INCURRED

  1. Owner agrees to pay the rate for boarding in effect on the date of pet check-in and to pay all costs and charges for special services requested and all veterinary costs during the time the pet is in the care of Fuzzie Buddies.
  2. All charges incurred by the Owner shall be payable upon pick-up of their pet. Owner also agrees that their pet shall not leave Fuzzie Buddies until all charges are paid.
  3. Fuzzie Buddies shall have, and is hereby granted a lien on the pet for any and all unpaid charges resulting form the pet’s stay at Fuzzie Buddies. If not paid, Fuzzie Buddies may exercise its lien rights upon ten days written notice given to Owner by certified mail to address shown on this contract. Fuzzie Buddies may use the pet as compensation for any and all unpaid charges.

CONTRACT TERMS AND CONDITIONS

  1. This contract contains the entire agreement between the parties. All terms and conditions of the Contract shall be binding of their heirs, administrators, personal representatives and assigns of the Owner and Fuzzie Buddies.
  2. Any controversy or claim arising out of, or relating to this contract, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this contract or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this contract, shall be settled in accordance with the rules of the American Arbitration Association and judgment upon the award rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of his award, determine an award to the prevailing party of the coast of such arbitration and reasonable attorney’s fees of the prevailing party.

Fuzzie Buddies Representative______Date______

Name of Owner______Date______

Signature of Owner______

Fuzzie Buddies Copyright 2010